It's two days before Christmas, an odd time to schedule a doctor's appointment I've been dreading. But since this was the only day the endocrinologist could see my 15-year-old transgender son, I combine the trip to Seattle with a look at holiday displays. First, Noah and his twin, Lydia, and I enjoy lunch at a fancy pizza parlor; then we visit the lobby of a hotel to see an exhibit of gigantic gingerbread creations. The theme is Star Wars. Hundreds of gummy bears face Anakin Skywalker speeding across the candy sand. There's an edible Yoda, and a tall gingerbread R2-D2.
The rain picks up on our way to the medical complex, so we speed along, seeing only blurry reflections of Christmas lights on the sidewalk. Once there, we take an elevator, I check Noah in, and the three of us wait in a room. Noah sits on the examination table near a tall window. Nine stories below, workers in bright orange collect trash from the buildings. The steel arms of green mega-machines lift bins and flip them with screeching and pounding into compacting hoppers.
Although I have talked with Dr. Stedman at a conference for families with transgender children, this is my first trip to his office with Noah. For six months, my grief over losing a daughter and my fear of hormones harming Noah kept me away. It was my husband, a scientist with an M.D. and a Ph.D. in biochemistry, who took Noah to an informational session in the spring and concluded that hormone therapy under medical supervision, with frequent blood tests, would be safe. He and Noah returned to Dr. Stedman in September when Noah had a hormone-blocker implanted in his arm. This suppression of estrogen stopped the menstrual cycle. When Dr. Stedman inserted the inch-and-a-half, spaghetti-like implant, he also gave Noah a prescription for an ointment containing a small dose of testosterone—"T" as Noah would say— to be administered like a roll-on deodorant. Dr. Stedman told Noah that in a few months he could return and perhaps go on a higher dose of T, which would then be injected.
So here we are. My husband and I are supporting Noah in the transition because we've come to accept that it is best for his mental health. What we thought could be a phase is clearly not. Starting female puberty was agonizing for Noah. The year after his first period, he spiraled down into a suicidal depression. His choice in living as a boy, with our family's acceptance, has given him hope, happiness, and a fresh outlook on life.
The current trend in transgender teen care, strongly endorsed by both endocrinologists and mental health care professionals, is to begin hormone blocker treatment close to the onset of puberty, then add cross-sex hormone therapy. If all goes to plan, Noah will go through male puberty in the next few years. His hormone level after today's treatment will be a 12-year-old boy's. He will then give himself injections each week. Every 6 months the dosage will go up, making him hormonally a 13-year-old male, then 14, increasing to an adult level of T matching his age at 18. The doctor will then take out his hormone blocker. Noah will gradually change appearance as other teen boys do. His voice will deepen, he'll increase muscle mass, and he'll grow facial and body hair. This prospect disturbs me profoundly, but I don't have to like it.
My thoughts are still swirling as Dr. Stedman walks in. He's a tall man of about 50, well- dressed, easygoing. He greets us with a smile. Noah proudly says he's grown two inches taller since the doctor put the hormone blocker in. Arresting female sexual maturity has caused this unanticipated effect. Lydia makes a face at Noah in mock-jealous protest. She doesn't think it's fair that her twin gets to be 5 foot 3 when she's 5 foot 1.
Noah reveals to the doctor that he has hot flashes, several a day. This is news to me. I flinch, and cover my eyes with my hand. The doctor, his voice light, assures Noah that once the T is increased the hot flashes will stop. He talks about Noah's estrogen levels dropping as casually as a small change in the weather.
"Would you like to start the testosterone injections today, Noah?"
"Yes!" Noah grins as wide as the Seattle sky outside the window.
I'm grateful for this window, and especially Lydia's presence, when the doctor leaves to get the hormone. The twins are completely devoted to each other. Lydia was the first to call Noah by his chosen name and pronoun. She not only accepted Noah's choice to transition, remarkably, she embraced it.
Noah, Lydia and I watch what's happening on the street below. A large truck blocks traffic, and people get out of their cars, waving and calling out. Another welcome diversion.
This is not the time to nurse my grief or brood. After many conversations, my husband and I have agreed for Noah to make his own choice about T. I aim to be one-hundred-percent in support of my son.
The doctor returns, seemingly cheerful as ever, and brings out the syringe. I pray to God, for Noah, myself, everyone in the room. Dr. Stedman teaches Noah to draw up the T, a yellowish substance, from the vial. The doctor warns about air bubbles, which could enter Noah's bloodstream with fatal results. Noah learns to clear the syringe by tapping it and pushing the bubbles out.
Lydia looks over with big eyes. Maybe she's worried about her brother feeling pain. My heart is racing.
Still grinning, Noah takes the vial and pulls the plunger to the right number as Dr. Stedman talks arithmetic and dosages with Noah. He is pleased by Noah's aptitude, both in mastering the syringe and figuring numbers. Next, Noah learns to exchange the vial needle with the slimmer injection needle.
"Noah, do you want to inject yourself in the stomach or the leg?" the doctor asks.
Noah pulls up his plaid flannel shirt and hoodie. The doctor inspects his skinny frame.
"Let's go for the leg," Noah says.
"Good choice," the doctor says. I am grateful for his cheer. With a sheet over his boxer shorts, Noah uncovers his right leg. At the doctor's instruction, Noah chooses a spot on his thigh and wipes it with alcohol.
"Try to relax your muscles," the doctor says. "It will sting less."
Dr. Stedman tells Noah to form a V with the other hand, take a ninety-degree angle and "break through the skin quickly."
Noah seems subdued. His face shows apprehension, but excitement, too.
Lydia's expression is veiled. "I can't watch this," she says, and turns to the window. She's scared of the needle, but I have deeper fear about what will become of Noah with the physical transformation. Will he like his new appearance? Will he have regrets, feel alone, become depressed again?
I'm gripping the edge of my chair. But I don't look away.
Noah's expression becomes stoic; he's determined to show his bravery. He inserts the needle without flinching and pushes the T into his muscle.
Then, as he pulls the needle out, he smiles. It's clear he feels an enormous sense of accomplishment.
"Do you feel any burning?" Dr. Stedman asks.
The doctor gives Noah a bandage for the tiny wound, and Noah pulls up his jeans.
It's over. The hormone has gone through skin and muscle, and into his bloodstream, to work its mysterious power to transform my daughter into my son. Weekly shots might well be a routine for the rest of Noah's life. That, at least at the moment, does not appear to phase him. Nor does the likelihood of never being a biological parent. The doctor tells Noah to come back in a week, and at that time he'll look on as Noah gives himself his second shot of T.
Lydia puts her arm around Noah and rests her head on his shoulder.
We thank the doctor and go out into the rain. It's still midafternoon, and there's a lot to see in this area of downtown to hopefully give my teens pleasant thoughts from the trip. At a nearby park, we watch soaking-wet children ride the horses of the nineteenth century carousel outlined with lights. The Christmas tree shines radiantly in the gloom.
Ducking from the rain, we go in and out of the large department stores, and rate the window displays. For a fleeting minute, a curving toy train captivates the twins as when they were very young. We stand under one store's high shooting star, and I tell Lydia and Noah about the Christmases of my childhood, New York City's holiday extravaganza, its grand scale, and seeing The Nutcracker at Lincoln Center. My beautiful, educated, highly cultured mother gave me wonderful experiences.
Still, on this day of lights and shadows, I can't keep from recalling my mother's domineering side. She believed with absolute surety that she knew what was best for me, far better than I ever would. Clouded by her fears, she kept me from making decisions, and I became anxious and insecure.
Noah and Lydia peer into a few more store windows. Later, as we wait for the bus under an awning in the dark, I feel quite pleased. This day could have been grim for me, but thanks to some diversions and shared time with my children, it wasn't. My hope is that they will look back on our time with a memory of colored lights, and a strong assurance that it is okay to take decisive steps in creating a life filled with joy.